Conference Presentations

Transitioning from an inpatient, post-acute rehabilitation unit to the community can pose numerous challenges for clients following acquired brain injury (TBI) and increase burden of care for their families. This pilot project evaluated the supports and barriers present in optimising transition for clients into the community following a moderate-severe TBI. A retrospective audit was undertaken to investigate practice patterns and themes that aided or inhibited transition to the community. Descriptive statistics report the frequency of clients returning to their pre-injury accommodation (e.g., private residence). From this cohort (n = 5), qualitative interview of clients and a family member was carried out to investigate patterns and themes of discharge transitioning using a client-centred model. Primary tested themes include the importance of early discharge planning, early identification of and referral for a rehabilitation community provider and collaboration with the community provider prior to discharge, to ensure continuity of care. Additionally, collaboration with the general practitioner and accessing the patients familiar community facilities from the post-acute inpatient setting (e.g., bus, shops, library) has been highlighted. These themes were cross-referenced against family/whanau/support person beliefs. There are numerous key themes that may facilitate increasingly streamlined transition from intensive rehabilitation to pre-injury community accommodation that can be incorporated into clinical practice. This will likely have a positive impact on provision of care, potentially increasing the ability for principles trained during inpatient rehabilitation to generalise to the community.

AFRM/NZRA Rehabilitation Conference 2015 - Building Good Rehabilitation by Design

Included presentations by all three providers of the new TBI residential rehabilitation service in New Zealand.

The discussion evidenced the need for equitable remuneration for the same service, transparent and evidence based approach, where the input of providers and the funder were openly considered and discussed. The collaborative consultation between the funder and providers achieved these results and demonstrated how the collection of consistent data across the whole country is a powerful step forward in understanding TBI in New Zealand.

Post-acute traumatic brain-injured patients are referred to the Laura Fergusson Trust (LFT) with a plethora of complex clinical and medical conditions. These issues can affect the patients’ ability to effectively participate in rehabilitation. Non-government organisations (NGOs) are now more visibly recognised as part of the ‘whole health system’; however, access to clinical and medical information regarding individual patients was previously reliant on faxes, lengthy telephone calls and paper copies of notes received many days after the information was required. This scenario presented many issues, including the inability to access current information in a timely and efficient manner, privacy and information-sharing issues and the protracted length of time taken to complete clinical assessments. In particular, determining the range of information required relied heavily on clinical judgement and experience. HealthOne enables healthcare providers to deliver improved outcomes for people seeking community, primary and/or secondary health services by sharing vital patient data across multiple organisations including NGOs. Patients transcend many different clinical pathways following illness or injury, particularly once they are discharged back into the community. These pathways, traditionally provided by DHB have now transformed, and we have seen the growth of NGO health providers as part of the whole health system. Our case study told the story of a patient's journey through complex clinical pathways and how access to HealthOne has led to a myriad of quality improvements for the patient.

Abstracts

The experiences of individuals with a spinal cord injury following discharge from inpatient rehabilitation

There is a growing body of literature investigating community reintegration following spinal cord injury (SCI). Little research, however, examines interactions between individuals with SCI and the community health providers who have considerable involvement with them. This study explored how individuals with SCI viewed the interactions they had with community health providers following discharge from inpatient rehabilitation. Six participants (between one and four years after SCI) participated in individual semi-structured interviews. The interviews were analysed using thematic analysis. Three themes emerged: (a) Understanding of processes and systems, (b) Knowing what is available and (c) Continuity of care. These themes led to an overarching sense of empowerment encompassing the participants having control, options, choice and being able to get on with life. The findings suggested that individuals with spinal cord injury wish to be empowered to have control over their lives as they transition back to their community.

Community reintegration following spinal cord injury: Insights for health professionals in community rehabilitation services in New Zealand.

When returning home following a spinal cord injury (SCI), individuals will be in contact with a range of health professionals who will be involved in their ongoing rehabilitation. This study explored the qualitative literature to determine what individuals with SCI perceive to be the barriers or facilitators to community reintegration to provide insights for health professionals working in community rehabilitation services in New Zealand. The databases of Ovid Medline, CINAHL, the Allied and Complementary Medicine Database (AMED), Cochrane Database of Systematic Reviews and PEDro were searched for relevant articles. Barriers and facilitators to community reintegration were classified into the International Classification of Functioning, Disability and Health (ICF) framework with the addition of self-management factors to further define personal factors. Of the 381 studies uncovered in the search, seven met the inclusion criteria. Findings revealed that accessibility of the environment, re-establishing self, support and connections were strong themes for reintegration. The challenge for health professionals working in the community with individuals with SCI is to be client-centred and ensure the individual’s needs are suitably met to support them to re-connect with their work and community life.

Comparison of a Virtual-Reality Test of Executive Function with Standard Executive Function Tests and their Ecological Validity

Despite the availability of numerous standardized tests of executive functions (EF) many EF tests have low ecological validity, as they do not resemble the real-life situations that typically require the use of those cognitive functions. This lack of ecological validity is problematic in that it limits the ability of these tests to predict real-life functioning, and this issue has lead to the development of several EF tests designed to have improved ecological validity. One such test is the Jansari assessment of Executive Functions (JEF; Jansari et al., 2004), which utilizes virtual reality technology. The central aim of the above named project is to examine the ability of the JEF to predict the real-life behaviour of people with and without brain-injuries, and how this test compares to other standard psychological tests in its ability to do so. Other aims of this project are to see how well the virtual-reality test can identify brain-injured from non brain-injured people, as well as establish preliminary normative data, which will ultimately contribute to an international data set for this test. If the virtual-reality test performs well compared to the other tests, this would support the test’s use in routine assessments of brain-injured people.

A more "normal" life: Residents', family, staff, and managers' experience of active support at a residential facility for people with physical and intellectual impairments.

Graham F, Sinnott K, Snell D, Martin R, Freeman C.

J Intellect Dev Disabil. 2013 Sep;38(3):256-64.

Active support (AS) has gained popularity as an approach for assisting people with intellectual disability to engage more fully in everyday activities. Although research has identified changes in the extent that residents are engaged in meaningful activities, the experience of stakeholders such as residents, staff, and family in AS is underexplored. A general inductive approach was used to analyse focus group and interview transcripts of residents (n = 4), staff (n = 13), and family (n = 2) about their experience of involvement in an AS pilot project at one residential care facility in New Zealand. Three superordinate themes common to all stakeholders' experiences emerged: "living normal lives," "caring means doing with," and "engaging with risk." Transitioning to AS had been enriching but at times challenging for all stakeholders. Valuing resident autonomy and preparedness for greater exposure to risk are significant considerations in the implementation of AS.